Southwest Institute for Health Disparities Research The Mexican Healthcare System and the US-Mexico Migratory Population Octavio Mojarro New Mexico State University December 2, 2016 1
OBJECTIVES Describe the national health system of Mexico Inform academics, researchers and students in the U.S. about the health system in Mexico and increase opportunities for collaborative work Encourage research into the health status and health care needs of the mobile, transborder population 2
NATIONAL HEALTH SYSTEM OF MEXICO Sector Seguridad social Público Secretaría de Salud, SESA Privado Fondos Contribución gubernamental Contribución del empleador Contribución de los empleados Recursos de los gobiernos estatales Recursos del gobierno federal Individuos Empleadores Compradores PEMEX Otros Seguro Popular de Salud Cuotas de recuperación Cuotas familiares ISSSTE IMSS Secretaría de Salud y SESA IMSS- Oportunidades Aseguradoras privadas Proveedores Hospitales Clínicas Médicos Hospitales Clínicas Médicos Hospitales Clínicas Médicos Proveedores privados Usuarios Trabajadores del sector formal Familias de los trabajadores Jubilados Auto-empleados, trabajadores del sector informal, desempleados y personas fuera del mercado de trabajo Población con capacidad de pago 3
NATIONAL HEALTH SYSTEM OF MEXICO In accordance with federal health law, Mexico s National Health System is administered by government agencies at the federal, state and local levels; private providers; and not-for-profit organizations a) Seguridad Social / federal social security institutions (IMSS, ISSSTE, PEMEX, SEDENA, and SEMAR) Services are provided on a prepaid basis by contributions from employers and employees and the federal government: IMSS (private sector, government and employees), ISSSTE (Federal government and employees), PEMEX (National Oil company and employees), SEDENA (Army) or SEMAR (Navy). 4
b) Secretaría de Salud (SESA)/ federal, state and jurisdictional health departments Provides health care to those not covered by the federal social security institutions mentioned in (a) Financed by resources from the federal government, state governments and individuals (sliding scale according to income level) A specific program that targets the underserved, IMSS- Opportunities or PROSPERA, is financed with federal funds and delivered through IMSS health services. 5
c) Seguro Popular en Salud (SPS) / the People s Health Insurance Fund Financed by federal resources, state resources and family contributions. Administered by state government State governments use funds to contract through SESA to finance health services Designed to reach persons not receiving social security/health insurance and not already registered with the Secretaría de Salud SPS began in 2004, serving 5.3 million Mexicans As of 2015, SPS is covering 57.1 million Mexicans 6
d) The private sector Is financed out of pocket by individuals at the time they receive the services And by premiums from private insurance companies 7
Level of decision responsibility NATIONAL (SESA, IMSS, ISSSTE...) NATIONAL HEALTH SYSTEM NATIONAL COORDINATION OF NATIONAL HEALTH SYSTEM: Secretary of Health Each institution designs policies, programs, budget and evaluation according to the national health system STATE / DELEGATIONAL (SESA, IMSS, ISSSTE...) STATE COORDINATION: Secretary of Health Each institution designs policies, programs, budget and evaluation according to the national and state health system JURISDICTION / ZONE (SESA, IMSS, ISSSTE...) JURISDICTIONAL COORDINATION: Secretary of Health Each institution applies federal and state policies and programs Coordinates health clinics and hospitals 8
Decision and responsibility levels The National Health System is organized by offices and institutions of the Public Administration, both federal and local. The Ministry of Health coordinates the National Health System, and is responsible for: Establishing and conducting the national health policies. Coordinating health service programs through the different agencies and institutions of the Federal Public Administration. The State governments will contribute in implementation of the National Health System, within the limits of their territories and in coordination with the Secretary of Health (SESA). The State governments will plan, organize and develop state health systems in their corresponding territory subdivisions, procuring their programmatic participation in the National Health System. 9
Financing of Seguro Popular de Salud (SPS) Annual contribution per person, 2015 Federal Contribution State Contribution Beneficiary Contrib. $73.98 dlls $49.3 dlls 3.92% of minimum salary, DF (Social Quota) 1.5 times Social Quota (SE) 0.5 times Social Quota (ASE) Social Quota Federal Contrib. State Contrib. Source: Health Law. $24.66 dlls In accordance with its capacity economic Family Quota (States collect ) 11
Origin and application of financial resources, Seguro Popular (SPS) 12
SECRETARIA DE SALUD DE NUEVO LEON (SESA) SUB. PREVENCIÓN Y CONTROL DE ENFERMEDADES. PUBLIC HEALTH HEALTH PROMOTION SUB. REGULARCION Y FOMENTO SANITARIOS CONTROL SANITARIO FOMENTO Y CALIDAD COESIDA (AIDS) OTRAS PREVENTION OF ACCIDENTS AND ADDICTIONS SEXUAL HEALTH, PROTECTION AND PREVENTION 13
SECRETARIA DE SALUD DE NUEVO LEON DIRECCIÓN GENERAL DE SERVICIOS DE SALUD DIR. ENSEÑANZA E INVESTIGACIÓN DIR. ADMINISTRATIVA DIR. SALUD Y BIENESTAR DIR. PLANEACÍÓN DIR. PROTECCIÓN SOCIAL EN SALUD DIR. JURISDICCIONES SANITARIAS DIR. SALUD MENTAL Y ADICCIONES DIR. JURIDICA 14
Jurisdictional Divisions State of Sonora 15
STRUCTURE OF THE HEALTH JURISDICTIONS Jefe Cd. Juárez Chihuahua Jurisdiccional Dr. Juan Noé López Soto 2 Coordinator of health services 3 Coordinator of epidemiology 4 Coordinator of preventive medicine 5 Coordinator of reproductive health 6 Coordinator of child and adolescent health 7 Coordinator of administration 8 Coordinator of planning and sectors 9 Coordinator of training and teaching 10 Coordinator of Seguro Popular 11 Head of information and public relations 16
70 Coverage of Seguro Popular de Salud (SPS), 2004-2015 (Millions of people) 60 50 43.7 51.8 52.9 55.6 57.3 57.1 40 30 20 10 5.3 11.4 15.7 21.8 27.2 31.3 0 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 17 Source: INFORME DE RESULTADOS DEL SPSS. ENERO DICIEMBRE 2015
180,000.00 160,000.00 140,000.00 120,000.00 Budget of Seguro Popular de Salud (SPS) 2004-2015 (millions of pesos) (8.3 billion US dollars in 2015) 122,799.40 146,176.60 138,695.10 166,268.50 159,275.30 100,000.00 80,000.00 60,000.00 40,000.00 20,000.00 18,852.40 7,750.10 33,089.10 50,410.00 69,214.70 91,313.10 88,340.70 0.00 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 18 Source: INFORME DE RESULTADOS DEL SPSS. ENERO DICIEMBRE 2015
% Distribution of population by health insurance/provider affiliation and state TAMAULIPAS NUEVO LEÓN NATIONAL 19
% Distribution of population of Seguro Popular de Salud (SPS) by income decile and state TAMAULIPAS NUEVO LEON NATIONAL 20
% Distribution of last health institution used, national population 5.63 1.45 0.89 14 9.1 38.62 SESA (SP) IMSS PRIVATE FARMACIA PHARMACY ISSSTE+ NONE 30.31 PEMEX+ Source: Intercensal Survey. INEGI. 2015. 21
Summary The Mexican health system has achieved high coverage. However, there are important issues yet to resolve: Inequality and lack of access to health services among rural, marginalized and indigenous populations Variable quality in basic health services Duplication in services due to poor coordination (People share IMSS & ISSSTE;ISSSTE & PRIVATE;SESA & OPORTUNIDADES) Under appreciation for Seguro Popular in some cultural subpopulations, who continue to spend resources on private health care services 22
POPULATION MOBILITY AND HEALTH 23
Mobility and Health in the Migrant and Border Populations We have information on migration patterns and population dynamics, but little on health in migrant populations. 4 of 10 Mexicans in the US do not have health insurance (CONAPO) Mexican and US residents cross the border daily in search of health services, including reproductive health and childbirth services, but we know little about these patterns In addition to Mexican migrants, 100,900 Central American are returned by US migration through Mexico. Refugees in Mexico (Central American and Haitian) are looking to pass to US Many other migrant flows, including laborers, tourists, and 24 others with unknown health care status and needs
Millions Mexicans and Mexican immigrants in the U.S. Mexican immigrants to US decline; half are estimated to be undocumented (otro flujo) 40 35 Mexicans in US 35.8 30 25 20 15 11.8 11.5 10 5 0 Mexican immigrants to US 1994 1995 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 Fuente:CONAPO. Yearbook of migration and remittances. Mexico 2015 25
Balance of international migration flow in Mexico,* 2005-2013 1,200,000 1,090,454 1,000,000 792,585 800,000 Mexican immigrants to the US. 600,000 400,000 200,000 0-200,000-400,000-600,000-800,000 437,303 331,791 2005 2006 2007 2008 2009 2010 2011 2012 2013-665,005 Mexican migrants returning to Mexico -236,095 Migratory balance 131,625-200,166 *Sourcce: CONAPO. Yearbook of migration and remittances. Mexico 2015 26
2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Overland labor migration flows Mexico-U.S., 2000-2013 (thousands) 900 816 856 800 700 681 729 628 709 748 630 600 500 455 559 542 493 400 300 200 328 406 325 326 255 364 404 438 404 245 317 214 276 322 288 100 165 0 Migrants to US from the south Returning migrants to Mexico from the US Source: CONAPO. Yearbook of migration and remittances. Mexico 2015 27
Events of repatriation of Mexican migrant children from the United States, 2000-2014* 140000 120000 116938 100000 80000 60000 40000 20000 63756 52535 43271 37756 26016 15524 16971 0 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 Source: CONAPO. Yearbook of migration and remittances. Mexico 2015 28
Summary and recommendations The Mexican migrant population has the right to health services but some groups lack access or do not know how to access them The population of the region moves from one country to another with special health care needs, but services do not follow. Each country serves their own. Portabilility in some basic services is needed. Migratory flows have not incorporated the needs and information of the migrant health and reproductive health: of labor migrants, returnees, refugees, undocumented and those looking for lower cost services Bi-national working groups could form to clarify the problem and make recommendations. 29
GRACIAS THANK YOU Octavio Mojarro CECOFIN octavio_mojarro@hotmail.com 30